NUR260 Final Exam

The nurse and a dietitian are instructing the client on a low-sodium diet needed to lower the blood pressure. Which question, asked by the nurse, is most important?

"How do you prepare your food?"

A client is placed on a low-sodium (500 mg/day) diet. Which client statement indicates that the nurse's nutrition teaching plan has been effective?

"I chose broiled chicken with a baked potato for dinner."

What statement made by client diagnosed w/terminal illness indicates achievement of fundamental goal of end-of-life care

"I'm physically and emotionally comfortable."

A client is scheduled for a diagnostic workup following a diagnosis of hypertension. The client is overtly anxious and crying. Which response by the nurse is most appropriate?

"Tell me what concerns you most."

An older female states she feels "old, wrinkled, and worthless." What is the nurse's best response?

"Tell me your concerns about feeling worthless."

The charge nurse should intervene when overhearing a gerontological nurse make which statement to a client?

"i wont give you your medicine until you behave"

The daughter of an older client is seen sitting outside, crying while talking with their spouse over the phone. What should the nurse say to the daughter>

"this must be very overwhelming for you"

The Geriatric Giants examples

Falls Incotinence Confusion Impaired homeostasis Iatrogenic disorders Anorexia of aging Depression

When teaching a client about hypertension and lifestyle changes what does the nurse emphasizes should be included in the diet?

Fresh fruits and vegetables

An older adult's family member asks the nurse what is meant by "holistic" care. What is the nurse's best response?

Health promotion through balance of the mind, body, and spirit

Prevalent health problems for african americans

Hypertension, heart disease, cancer, diabetes, and HIV/AIDS

poor nutritional intake nursing diagnosis

Imbalanced nutrition, less than body requirements related to anorexia, nausea/Vomiting

Which end of life nursing diagnosis is associated w/ the aging client + emaciaiton?

Impaired skin integrity

A client diagnosed with hypertension informs the nurse that they are not taking prescribed antihypertensive medications due to an absence of symptoms. What is the most appropriate response by the nurse?

Inform the client that this is why hypertension is known as "the silent killer."

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene?

Instruct the client to sit for several minutes before standing.

Older adult whose adult children have recently moved out of state appears depressed w/flat affect. Best RN response?

It's very normal to experience a sense of loss right now.

Jewish diet includes

Kosher diet!! (Exclusion of pork and shellfish, prohibit milk and meat at same meal or from same dishes)

Effects/Complications of Unrelieved Pain

Limited mobility Develop pressure ulcers Pneumonia Constipation Poor appetite Depression Hopelessness

A client hospitalized for treatment of hypertension is being prepared for discharge. Which teaching topic should the nurse should be sure to cover?

Maintaining a low-sodium diet

MOLST (medical orders for life sustaining treatment)

Medical orders that are effective immediately when patient consents & it is signed by provider

what are adjuvant medications?

Not normally used for pain but help with side effects (can be an anti-anxiety or sedative drug)

The charge nurse on a gerontological skilled care unit must intervene when making which observation?

Nursing assistants discussing incontinent episodes of clients in the hall

Which expected physical challenges occur when an older client is dying?

Pain, constipation + respiratory distress

ageism

Prejudices and stereotypes applied to older adults based on age

primary prevention

Prevents the disease before occurring (EX: immunization, education)

What is the nurse's best action to assist a client suffering from presbyopia?

Provide more light to see adequately.

When caring for a client with essential hypertension what instruction should the nurse provide to the client to normalize blood pressure?

Reduce sodium intake.

A client with primary hypertension reports dizziness with ambulation when taking the prescribed alpha-adrenergic blocker. When teaching this client, what should the nurse emphasize?

Rising slowly from a lying or sitting position

The nurse is caring for a client prescribed bumetanide for the treatment of stage 2 hypertension. Which finding indicates the client is experiencing an adverse effect of the medication?

Serum potassium value of 3.0 mEq/L

tertiary prevention

Soften impact of chronic illness, help people manage long term effects to help improve quality of life + expectancy

prevention examples

Support groups OT, PT + Rehab Exercise + diet changes

Ethnogeriatrics

The effects of ethnicity and culture on the health and well-being of older adults

Age Identity

When a person is one age but says they feel another or when one feels that those of the same age as them are older than they are.

What intervention demonstrates attention to a fundamental right of all individuals facing death?

When death is imminent, a staff member stays with a client who is dying

health care proxy

a person chosen by another person to make medical decisions if the second person becomes unable to do so

The major cause of death is now _____ disease.

chronic

Persistent pain

chronic pain that has been present for 3 months or longer

sign of hydration is a dec in ______ ______

creatine clerance

what puts elder at high risk for pneumonia

dec cilia

for elder adults as they age their sleep quality _______

decreases (not deep sleep, more light/moderate)

An older, widowed male spends most of his time home alone, reflecting on his past. He has resigned from his community positions. What aging theory does this clients behavior represent?

disengagement

Which end-of-life nursing diagnosis is associated with the aging client and fear?

disturbed thought proces

Nonstochastic theories

explain biological aging as resulting from a complex, predetermined process

Advance directive

express patient desires for terminal care and/or life-sustaining measures

Medicare

federally funded health insurance program designed to provide medical coverage to people who may no longer be eligible for employer sponsored health insurance.

a dec in what can cause elderly to process medication differently

gastric motility

Which statement made by a gerontological nurse to a new graduate nurse is most accurate?

healthcare system is currently greatly impacted by the aging of baby boomer

The higher the tier of the donut hole aka coverage gap the ...

higher the cost

objective data

information that is seen, heard, felt, or smelled by an observer; signs

Prevention as a goal for care for constipation

laxative + stool softeners, inc diet fiber + intake, activity if tolerated, bowel regimen

Neuropathic pain

occurs from an abnormal processing of sensory stimuli by the central or peripheral nervous system (DIABETES)

PHYSICAL CARE CHALLENGES

pain respiratory distress constipation poor nutritional intake

Palliative care is best described as:

provision of holistic care to patients experiencing incurable health states

The nurse teaches the importance of using sunscreen. Which theory of aging is the nurse's teaching based upon?

radiation

Patient Self-Determination Act

requires health care facilities to ask a patient about advance directives.

Which is the most important nursing action for the older dying client engaged in silent depression?

sitting silently

Pt upset because adult son wants pt to receive a specific treatment, but pt does not want. Which RN action?

support the client's right to refuse the treatment

subjective data

symptoms from the client's point of view (feelings, perceptions, and concerns)

The Dreaded "Donut Hole" =

the coverage gap

Stochastic theories

view the effects of biological aging as resulting from random assaults from both the internal and external environment

A nurse educator is providing information about hypertension to a small group of clients. A participant asks "What can I do to decrease my blood pressure and thus my risk for heart problems?" The nurse describes modifiable and non-modifiable risk factors. Which of the following risk factors can the client modify?

Dyslipidemia

signs of imminent death

1. Bodily functions slow down 2. Sleeps for long time 3. Dec resp rate w/ inc intervals between breaths (Cheyne-Stokes Respirations) 4. Death rattle 5. Week irregular pulse w low BP 6. Pallor 7. Peripheral + central cyanosis 8. Cool to touch 9. Incontinent 10. Loss of senses (believed hearing is last to go)

Constipation nursing interventions

1. Develop a patient-centered bowel program. 2. Identify causative & contributing factors for constipation 3. Monitor stools for consistency, amount, & frequency. 4. Review the patient's history of bowel patterns & compare with current patterns. 5. Administer prescribed medications & monitor for effect.

FACTORS INFLUENCED BY ETHNIC NORMS

1. Diet 2. Response to pain 3. Compliance with self-care and treatments 4. Trust with health care providers 5. Responsibilities and roles in old age

muslim diet includes

1. Eating only meat that is slaughtered according to religious requirements 2. No pork or pork products 3. Water with each meal 4. Periods of fasting.

Primary prevention examples

1. Education (safety + disease preventing) 2. Immunizations EX: support gr

Spiritual Assessment using FICA mnemonic

1. Faith & belief → religion, spirituality, faith: What gives your life meaning? 2. Importance & influence → What influence does faith have on your health? 3. Community → Are you a part of a community? Do you have support & what type? 4. Address in care → How to address these issues in your health care.

Respiratory distress nursing interventions

1. Monitor respiratory rate, depth, & effort, as ordered. 2. Monitor vital signs, as ordered. 3. Place the patient in a position that facilitates breathing (Folwers or semi-flowes) 4. Administer oxygen, as prescribed, & monitor the patient's response. 5. Administer prescribed medications & monitor effect. (Bronchodilators, morphine) 6. treat if under-lying cause (pneumonia = antibiotics)

Pain nursing interventions

1. Morphine + demerol used at end of life for severe pain 2. Pay attention to adverse effects such as psychosis

Acceptance nursing diagnosis and intervention during this stage

1. Nursing diagnosis = Impaired gas exchange RT dyspnea + anticipatory grief RT impending loss of significant other 2. Nursing intervention = apply supplemental O2, administer Morphine + provide supportive care

Anger nursing diagnosis and intervention during this stage

1. Nursing diagnosis = Ineffective coping 2. Intervention = Use active listening and acceptance to help clients express emotions such as crying, guilt, and anger (within appropriate limits).

Depression nursing diagnosis and intervention during this stage

1. Nursing diagnosis = Ineffective individual coping RT terminal diagnosis AEB depression or ineffective family coping RT depression 2. Nursing interventions = provide resources for spiritual support or counseling and arrange for visitation, per the patient's needs and request or discuss underlying reasons for patient behaviors with family.

Bargaining nursing diagnosis and intervention during this stage

1. Nursing diagnosis = Powerlessness related to terminal prognosis 2. Nursing intervention = Aid the patient in recognizing the importance of culture, religion, race, gender, and age on his or her sense of powerlessness.

Denial nursing diagnosis and intervention during this stage

1. Nursing diagnosis ex = spiritual distress related to cancer diagnosis 2. Intervention ex = Assist client with a life review and help client identify noteworthy experiences.

Secondary prevention examples

1. Screenings 2. Regular doc appointments EX:

poor nutritional intake nursing interventions

1. Stimulation of appetite (Steroids + Megestrol) 2. Monitor weight 3. Allow the family to bring in nutritious foods that the patient enjoys, if not contraindicated. 4. Assess the patient's oral condition and ability to swallow. (Oral thrush makes it hurt to swallow!) 5. Do they have teeth? 6. Small + frequent meals 7. Provide oral hygiene before and after meals and monitor response.

Living will

A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes.

The Patient Self Determination Act (PSDA)

Allowed patients in health care agencies to make their own decisions during treatments in the event they were not able to voice their own decisions

Respiratory distress nursing diagnosis

Altered breathing pattern (can be due to pneumonia, heart/kidney failure, CPOD, asthma + pulmonary embolism)

secondary prevention

Aims to reduce impact of disease that's already occurred - prevent + treat!! (EX: medications)

Leading chronic conditions in elderly

Arthritis Hypertension Hearing issues Heart conditions Visual impairments Orthopedic issues Diabetes Sinusitis Allergies Varicose Veins

An older adult client displays flat affect and is crying. RN notices open religious text in client's lap. RN action?

Ask the client if he or she would like to talk about what was just read.

What activity demonstrates a nurse's understanding of effective care for the dying client and the family?

Asking about needs and how the nurse can help meet them

The nurse feels a need to spend more time on spiritual health. What action should RN take to support this intention?

Attend a Bible study group on Wednesday evenings when able

A nurse on a busy medical unit is aware of the importance of accurate blood pressure (BP) measurement. To ensure accuracy when assessing patients' blood pressures, the nurse should always:

Ensure that the correct cuff size is used for each patient

Pt w/ history of cardiovascular disease refuses to stop eating canned soups + potato chips. The nurse should perform which priority assessment?

Blood pressure

Palliative Care

Care designed not to treat an illness but to provide physical and emotional comfort to the patient and support and guidance to his or her family.

the nurse visits the homes of a client who recently died. Which statement best explains the reason for the nurses visit?

Check on the family to make sure a crisis is not occuring

The Geriatric Giants are...

Conditions associated with the aging process.

A nurse developing a community health program is determining barriers to community resource referrals. Which of the following is an example of a resource barrier?

Costs associated with services

Elisabeth Kubler-Ross's 5 stages of grief

Denial Anger Bargain Depression Acceptance

A public health nurse is reviewing the outcomes of an exercise program at various locations. Which of the following aspects of care does this finding evaluate?

Equity

When establishing a bowel routine for an older adult, what should the nurse include in the plan of care?

Establish a toileting schedule.

A patient has been diagnosed with prehypertension and has been encouraged to exercise regularly and begin a weight loss program. What other healthcare professional may be helpful for the client to see?

Dietician

Acute pain

abrupt onset and lasting a short time

Older adult clients are sensitive to the _____ effect of opiates.

analgesic

Nociceptive pain

arises from mechanical, thermal, or chemical noxious stimuli; can be somatic or visceral

The American Nurses Association states that nursing participation in...

assisted suicide is a violation of the Code for Nurses and prohibits participation in assisted suicide and euthanasia

Hospice Care

begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness (Terminal illness w/ life expectancy less than 6 months)